Healthcare Provider Details

I. General information

NPI: 1295079218
Provider Name (Legal Business Name): DEBRA M LATZEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GLEN DR
RIDGE NY
11961-1636
US

IV. Provider business mailing address

205 GLEN DR
RIDGE NY
11961-1636
US

V. Phone/Fax

Practice location:
  • Phone: 516-941-5946
  • Fax:
Mailing address:
  • Phone: 516-941-5946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number606902-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: